AB50-ASA2-AA16,55,2121b. Assessing spending for specific prescription drug products in this state. AB50-ASA2-AA16,55,2222c. Accessing other available pricing information. AB50-ASA2-AA16,55,2323(b) The board may do any of the following: AB50-ASA2-AA16,56,1
11. Promulgate rules for the administration of this subchapter. AB50-ASA2-AA16,56,622. Enter into a contract with an independent 3rd party for any service 3necessary to carry out the powers and duties of the board. Unless written 4permission is granted by the board, any person with whom the board contracts may 5not release, publish, or otherwise use any information to which the person has 6access under the contract. AB50-ASA2-AA16,56,97(c) The board shall establish and maintain a website to provide public notices 8and make meeting materials available under sub. (3) (a) and to disclose conflicts of 9interest under sub. (4) (d). AB50-ASA2-AA16,56,1310(3) Meeting requirements. (a) Pursuant to s. 19.84, the board shall provide 11public notice of each board meeting at least 2 weeks prior to the meeting and shall 12make the materials for each meeting publicly available at least one week prior to 13the meeting. AB50-ASA2-AA16,56,1614(b) Notwithstanding s. 19.84 (2), the board shall provide an opportunity for 15public comment at each open meeting and shall provide the public with the 16opportunity to provide written comments on pending decisions of the board. AB50-ASA2-AA16,56,1917(c) Notwithstanding subch. V of ch. 19, any portion of a meeting of the board 18concerning proprietary data and information shall be conducted in closed session 19and shall in all respects remain confidential. AB50-ASA2-AA16,56,2120(d) The board may allow expert testimony at any meeting, including when the 21board meets in closed session. AB50-ASA2-AA16,57,222(4) Conflicts of interest. (a) A member of the board shall recuse himself 23or herself from a decision by the board relating to a prescription drug product if the
1member or an immediate family member of the member has received or could 2receive any of the following: AB50-ASA2-AA16,57,431. A direct financial benefit deriving from a determination, or a finding of a 4study or review, by the board relating to the prescription drug product. AB50-ASA2-AA16,57,752. A financial benefit in excess of $5,000 in a calendar year from any person 6who owns, manufactures, or provides a prescription drug product to be studied or 7reviewed by the board. AB50-ASA2-AA16,57,118(b) A conflict of interest under this subsection shall be disclosed by the board 9when hiring board staff, by the appointing authority when appointing members to 10the board, and by the board when a member of the board is recused from any 11decision relating to a review of a prescription drug product. AB50-ASA2-AA16,57,1512(c) A conflict of interest under this subsection shall be disclosed no later than 135 days after the conflict is identified, except that, if the conflict is identified within 145 days of an open meeting of the board, the conflict shall be disclosed prior to the 15meeting. AB50-ASA2-AA16,57,2016(d) The board shall disclose a conflict of interest under this subsection on the 17board’s website unless the chairperson of the board recuses the member from a 18final decision relating to a review of the prescription drug product. The disclosure 19shall include the type, nature, and magnitude of the interests of the member 20involved. AB50-ASA2-AA16,57,2321(e) A member of the board or a 3rd-party contractor may not accept any gift or 22donation of services or property that indicates a potential conflict of interest or has 23the appearance of biasing the work of the board. AB50-ASA2-AA16,58,32601.79 Drug cost affordability review. (1) Identification of drugs. 3The board shall identify prescription drug products that are any of the following: AB50-ASA2-AA16,58,74(a) A brand name drug or biologic that, as adjusted annually to reflect 5adjustments to the U.S. consumer price index for all urban consumers, U.S. city 6average, as determined by the U.S. department of labor, has a launch wholesale 7acquisition cost of at least $30,000 per year or course of treatment. AB50-ASA2-AA16,58,118(b) A brand name drug or biologic that, as adjusted annually to reflect 9adjustments to the U.S. consumer price index for all urban consumers, U.S. city 10average, as determined by the U.S. department of labor, has a wholesale acquisition 11cost that has increased by at least $3,000 during a 12-month period. AB50-ASA2-AA16,58,1412(c) A biosimilar that has a launch wholesale acquisition cost that is not at 13least 15 percent lower than the referenced brand biologic at the time the biosimilar 14is launched. AB50-ASA2-AA16,58,1815(d) A generic drug that has a wholesale acquisition cost, as adjusted annually 16to reflect adjustments to the U.S. consumer price index for all urban consumers, 17U.S. city average, as determined by the U.S. department of labor, that meets all of 18the following conditions: AB50-ASA2-AA16,59,2191. Is at least $100 for a supply lasting a patient for a period of 30 consecutive 20days based on the recommended dosage approved for labeling by the federal food 21and drug administration, a supply lasting a patient for a period of fewer than 30 22days based on the recommended dosage approved for labeling by the federal food
1and drug administration, or one unit of the drug if the labeling approved by the 2federal food and drug administration does not recommend a finite dosage. AB50-ASA2-AA16,59,632. Increased by at least 200 percent during the preceding 12-month period, as 4determined by the difference between the resulting wholesale acquisition cost and 5the average of the wholesale acquisition cost reported over the preceding 12 6months. AB50-ASA2-AA16,59,97(e) Other prescription drug products, including drugs to address public health 8emergencies, that may create affordability challenges for the health care system 9and patients in this state. AB50-ASA2-AA16,59,1410(2) Affordability review. (a) After identifying prescription drug products 11under sub. (1), the board shall determine whether to conduct an affordability 12review for each identified prescription drug product by seeking stakeholder input 13about the prescription drug product and considering the average patient cost share 14of the prescription drug product. AB50-ASA2-AA16,59,2015(b) The information used to conduct an affordability review under par. (a) may 16include any document and research related to the manufacturer’s selection of the 17introductory price or price increase of the prescription drug product, including life 18cycle management, net average price in this state, market competition and context, 19projected revenue, and the estimated value or cost-effectiveness of the prescription 20drug product. AB50-ASA2-AA16,59,2321(c) The failure of a manufacturer to provide the board with information for an 22affordability review under par. (b) does not affect the authority of the board to 23conduct the review. AB50-ASA2-AA16,60,8
1(3) Affordability challenge. When conducting an affordability review of a 2prescription drug product under sub. (2), the board shall determine whether use of 3the prescription drug product that is fully consistent with the labeling approved by 4the federal food and drug administration or standard medical practice has led or 5will lead to an affordability challenge for the health care system in this state, 6including high out-of-pocket costs for patients. To the extent practicable, in 7determining whether a prescription drug product has led or will lead to an 8affordability challenge, the board shall consider all of the following factors: AB50-ASA2-AA16,60,109(a) The wholesale acquisition cost for the prescription drug product sold in 10this state. AB50-ASA2-AA16,60,1411(b) The average monetary price concession, discount, or rebate the 12manufacturer provides, or is expected to provide, to health plans in this state as 13reported by manufacturers and health plans, expressed as a percentage of the 14wholesale acquisition cost for the prescription drug product under review. AB50-ASA2-AA16,60,1815(c) The total amount of the price concessions, discounts, and rebates the 16manufacturer provides to each pharmacy benefit manager for the prescription drug 17product under review, as reported by the manufacturer and pharmacy benefit 18manager and expressed as a percentage of the wholesale acquisition cost. AB50-ASA2-AA16,60,2019(d) The price at which therapeutic alternatives to the prescription drug 20product have been sold in this state. AB50-ASA2-AA16,60,2321(e) The average monetary concession, discount, or rebate the manufacturer 22provides or is expected to provide to health plan payors and pharmacy benefit 23managers in this state for therapeutic alternatives to the prescription drug product. AB50-ASA2-AA16,61,3
1(f) The costs to health plans based on patient access consistent with labeled 2indications by the federal food and drug administration and recognized standard 3medical practice. AB50-ASA2-AA16,61,54(g) The impact on patient access resulting from the cost of the prescription 5drug product relative to insurance benefit design. AB50-ASA2-AA16,61,76(h) The current or expected dollar value of drug-specific patient access 7programs that are supported by the manufacturer. AB50-ASA2-AA16,61,108(i) The relative financial impacts to health, medical, or social services costs 9that can be quantified and compared to baseline effects of existing therapeutic 10alternatives to the prescription drug product. AB50-ASA2-AA16,61,1211(j) The average patient copay or other cost sharing for the prescription drug 12product in this state. AB50-ASA2-AA16,61,1313(k) Any information a manufacturer chooses to provide. AB50-ASA2-AA16,61,1414(L) Any other factors as determined by the board by rule. AB50-ASA2-AA16,61,1815(4) Upper payment limit. (a) If the board determines under sub. (3) that use 16of a prescription drug product has led or will lead to an affordability challenge, the 17board shall establish an upper payment limit for the prescription drug product after 18considering all of the following: AB50-ASA2-AA16,61,19191. The cost of administering the drug. AB50-ASA2-AA16,61,20202. The cost of delivering the drug to consumers. AB50-ASA2-AA16,61,21213. Other relevant administrative costs related to the drug. AB50-ASA2-AA16,62,422(b) For a prescription drug product identified in sub. (1) (b) or (d) 2., the board 23shall solicit information from the manufacturer regarding the price increase. To
1the extent that the price increase is not a result of the need for increased 2manufacturing capacity or other effort to improve patient access during a public 3health emergency, the board shall establish an upper payment limit under par. (a) 4that is equal to the cost to consumers prior to the price increase. AB50-ASA2-AA16,62,85(c) 1. The upper payment limit established under this subsection shall apply 6to all purchases and payor reimbursements of the prescription drug product 7dispensed or administered to individuals in this state in person, by mail, or by other 8means. AB50-ASA2-AA16,62,1992. Notwithstanding subd. 1., while state-sponsored and state-regulated 10health plans and health programs shall limit drug reimbursements and drug 11payment to no more than the upper payment limit established under this 12subsection, a plan subject to the Employee Retirement Income Security Act of 1974 13or Part D of Medicare under 42 USC 1395w-101 et seq. may choose to reimburse 14more than the upper payment limit. A provider who dispenses and administers a 15prescription drug product in this state to an individual in this state may not bill a 16payor more than the upper payment limit to the patient regardless of whether a 17plan subject to the Employee Retirement Income Security Act of 1974 or Part D of 18Medicare under 42 USC 1395w-101 et seq. chooses to reimburse the provider above 19the upper payment limit. AB50-ASA2-AA16,62,2120(5) Public inspection. Information submitted to the board under this 21section shall be open to public inspection only as provided under ss. 19.31 to 19.39. AB50-ASA2-AA16,63,222(6) No prohibition on marketing. Nothing in this section may be construed 23to prevent a manufacturer from marketing a prescription drug product approved by
1the federal food and drug administration while the prescription drug product is 2under review by the board. AB50-ASA2-AA16,63,73(7) Appeals. A person aggrieved by a decision of the board may request an 4appeal of the decision no later than 30 days after the board makes the 5determination. The board shall hear the appeal and make a final decision no later 6than 60 days after the appeal is requested. A person aggrieved by a final decision of 7the board may petition for judicial review in a court of competent jurisdiction. AB50-ASA2-AA16,63,159(1) Staggered terms for prescription drug affordability review board. 10Notwithstanding the length of terms specified for the members of the prescription 11drug affordability review board under s. 15.735 (1) (b) to (e), 2 of the initial 12members shall be appointed for terms expiring on May 1, 2027; 2 of the initial 13members shall be appointed for terms expiring on May 1, 2028; 2 of the initial 14members shall be appointed for terms expiring on May 1, 2029; and 2 of the initial 15members shall be appointed for terms expiring on May 1, 2030. AB50-ASA2-AA16,63,2017(1) Prescription drug affordability review board. The treatment of ss. 1815.07 (3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 19and Section 9123 (1) of this act take effect on the first day of the 7th month 20beginning after publication.”. AB50-ASA2-AA16,64,2
1632.869 Reimbursement to federal drug pricing program 2participants. (1) In this section: AB50-ASA2-AA16,64,73(a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D), 4(E), (J), or (N) that participates in the federal drug pricing program under 42 USC 5256b, a pharmacy of the entity, or a pharmacy contracted with the entity to 6dispense drugs purchased through the federal drug pricing program under 42 USC 7256b. AB50-ASA2-AA16,64,88(b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c). AB50-ASA2-AA16,64,109(2) No person, including a pharmacy benefit manager or 3rd-party payer, may 10do any of the following: AB50-ASA2-AA16,64,1411(a) Reimburse a covered entity for a drug that is subject to an agreement 12under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies 13that are not covered entities and have a similar prescription volume to that of the 14covered entity. AB50-ASA2-AA16,64,1715(b) Assess a covered entity any fee, charge back, or other adjustment on the 16basis of the covered entity’s participation in the federal drug pricing program under 1742 USC 256b. AB50-ASA2-AA16,64,2018(3) The commissioner may promulgate rules to implement this section and to 19establish minimum reimbursement rates for covered entities and any other entity 20described under 42 USC 256b (a) (4).”. AB50-ASA2-AA16,65,223601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
1administrative organization under s. 632.864, an amount to be set by the 2commissioner by rule. AB50-ASA2-AA16,65,54632.864 Pharmacy services administrative organizations. (1) 5Definitions. In this section: AB50-ASA2-AA16,65,66(a) “Administrative service” means any of the following: AB50-ASA2-AA16,65,771. Assisting with claims. AB50-ASA2-AA16,65,882. Assisting with audits. AB50-ASA2-AA16,65,993. Providing centralized payment. AB50-ASA2-AA16,65,10104. Performing certification in a specialized care program. AB50-ASA2-AA16,65,11115. Providing compliance support. AB50-ASA2-AA16,65,12126. Setting flat fees for generic drugs. AB50-ASA2-AA16,65,13137. Assisting with store layout. AB50-ASA2-AA16,65,14148. Managing inventory. AB50-ASA2-AA16,65,15159. Providing marketing support. AB50-ASA2-AA16,65,171610. Providing management and analysis of payment and drug dispensing 17data. AB50-ASA2-AA16,65,181811. Providing resources for retail cash cards. AB50-ASA2-AA16,65,2119(b) “Independent pharmacy” means a pharmacy operating in this state that is 20licensed under s. 450.06 or 450.065 and is under common ownership with no more 21than 2 other pharmacies. AB50-ASA2-AA16,65,2222(c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c). AB50-ASA2-AA16,66,2
1(d) “Pharmacy services administrative organization” means an entity 2operating in this state that does all of the following: AB50-ASA2-AA16,66,431. Contracts with an independent pharmacy to conduct business with a 3rd-4party payer on the independent pharmacy’s behalf. AB50-ASA2-AA16,66,752. Provides at least one administrative service to an independent pharmacy 6and negotiates and enters into a contract with a 3rd-party payer or pharmacy 7benefit manager on behalf of the independent pharmacy. AB50-ASA2-AA16,66,108(e) “Third-party payer” means an entity, including a plan sponsor, health 9maintenance organization, or insurer, operating in this state that pays or insures 10health, medical, or prescription drug expenses on behalf of beneficiaries. AB50-ASA2-AA16,66,1711(2) Licensure. (a) Beginning on the first day of the 12th month beginning 12after the effective date of this paragraph .... [LRB inserts date], no person may 13operate as a pharmacy services administrative organization without being licensed 14by the commissioner as a pharmacy services administrative organization under this 15subsection. In order to obtain a license under this paragraph, the person shall 16apply to the commissioner in the form and manner prescribed by the commissioner. 17The application for licensure under this paragraph shall include all of the following:
/2025/related/amendments/ab50/aa16_asa2_ab50
true
amends
/2025/related/amendments/ab50/aa16_asa2_ab50/70/_12
amends/2025/REG/AB50-ASA2-AA16,60,8
amends/2025/REG/AB50-ASA2-AA16,60,8
section
true